What are symptoms of insulin resistance? Insulin resistance is often accompanied by fatty liver. Contrary to what is generally thought, insulin resistance occurs due to obesity. However, with the effect of high insulin levels increasing adipose tissue, it becomes more difficult to lose weight. How is insulin resistance measured? How is it treated?
Endocrinology and Metabolic Diseases Specialists explained the curiosities about insulin resistance in children by defining insulin.
What is insulin?
Insulin is an important hormone produced in the pancreas that affects the metabolism of sugar, fat and protein in all body tissues.
What is insulin resistance?
Insulin resistance is a condition in which tissue response to the cellular effects of the hormone insulin decreases.
The first function of insulin is to ensure the passage of sugar (glucose), which is taken into the body with carbohydrate meals and enters the bloodstream, to muscle and adipose tissue. Thus, on the one hand, it reduces the blood sugar that rises after meals, and on the other hand, it meets the energy needs of the cells by using glucose.
If insulin sensitivity is reduced in the tissues, normal levels of insulin do not show sufficient effect and the glucose use capacity of the whole body decreases and blood sugar rises. The pancreas tries to break this resistance by working harder and increasing insulin production. Thus, insulin resistance is defined as the condition in which blood sugar levels are kept within normal limits thanks to high insulin levels.
Insulin resistance is a key feature in the development of type 2 diabetes and represents the early stage of the disease. In people with insulin resistance, the pancreas’ insulin production begins to decrease over the years, blood sugar levels gradually rise, and eventually type 2 diabetes (diabetes) develops.
Symptoms of insulin resistance:
Some symptoms of insulin resistance include:
- A waistline over 40 inches in men and 35 inches in women
- Blood pressure readings of 130/80 or higher
- A fasting glucose level over 100 mg/dL
- A fasting triglyceride level over 150 mg/dL
- A HDL cholesterol level under 40 mg/dL in men and 50 mg/dL in women
- Skin tags
- Patches of dark, velvety skin called acanthosis nigricans
What is the most common cause of insulin resistance?
- The most common cause of insulin resistance is obesity. However, not every individual with obesity has insulin resistance and it can rarely be seen in children and adults who are not overweight.
- In addition, insulin resistance can also occur as a physiological condition. For example, physiological insulin resistance develops due to the increase in growth and sex hormones during adolescence and resolves with the completion of puberty.
- A high-calorie diet, excessive sugar (carbohydrate) consumption and sedentary lifestyle cause insulin resistance along with obesity.
- In children, insulin sensitivity decreases as the amount of adipose tissue (fat storage) in the body increases.
- Adipose tissue accumulated around the navel, abdominal cavity and intra-abdominal organs, especially around the navel, is the cause of insulin resistance.
- Insulin resistance is often accompanied by fatty liver. Contrary to what is generally thought, obesity does not occur in children because they have insulin resistance, insulin resistance occurs due to obesity. However, with the effect of high insulin levels increasing adipose tissue, it becomes more difficult to lose weight.
What is insulin resistance syndrome?
The combination of obesity, type 2 diabetes, hypertension and dyslipidemia (blood fat disorders) is called metabolic syndrome. The common mechanism linking these diseases is insulin resistance. This condition, also called insulin resistance syndrome;
- It increases the incidence of cardiovascular diseases such as atherosclerosis and coronary heart disease.
- It can also cause menstrual irregularities and excessive hair growth due to polycystic ovary syndrome in girls.
How is insulin resistance measured?
- For the diagnosis of insulin resistance, methods such as fasting insulin measurement, insulin evaluation in glucose loading tests, measurement of blood glucose and insulin levels together and calculation of some indices are used. However, none of these methods are successful enough to measure whole-body insulin sensitivity in children.
- In physical examination; Brown darkening (acanthosis nigricans) in skin fold areas such as neck, nape, armpits and groin is an indicator of insulin resistance. However, the absence of this symptom does not rule out insulin resistance, and it can also occur in some people without insulin resistance.
What is important in the treatment process?
- The treatment of insulin resistance is through weight loss with a healthy diet and exercise.
- Consuming less sugary and fatty foods, preferring whole grain and high-fiber, low-glycemic index (slowly raising blood sugar) foods increase insulin sensitivity.
- Aerobic exercises are effective in reducing muscle insulin resistance.
- If there is resistance to weight loss despite a healthy diet and exercise, drug treatments that increase insulin sensitivity can be given. The only drug approved for this purpose is metformin, which can be used in children over 10 years of age.
As a result, age changes, including diet and exercise, increase insulin sensitivity and prevent future diabetes, high blood pressure, and cardiovascular disease. In some selected special cases, drugs can be added to the treatment.
HOMA-IR test
The very mention of diabetes can strike fear in the heart of the bravest. It is known to adversely affect several organs in the body like the eyes, kidneys, nerves, heart and many more. If not diagnosed on time and treated, it can lead to several complications. You may have read plenty of blogs on how you can manage diabetes or about the measures you can adopt to prevent the onset of this disorder. But are you aware there is a test that can predict your chances of developing diabetes? It’s called the HOMA-IR (Homeostatic Model Assessment of insulin resistance) test. This test can help you in preventing diabetes.
Besides HOMA-IR, there are several other diagnostic tests that are used for testing for diabetes. Get in touch with your doctor to find out which test you should opt for and how to prepare yourself for it. Remember, the earlier the diagnosis, the easier and more effective the treatment procedures are going to be!
HOMA IR will ring the warning bells as soon as it registers even the slightest resistance to insulin in the pre-diabetes stage so that you can take the necessary steps to prevent a full-blown attack of diabetes.
Acute illness and stress are the two clinically often neglected conditions where fasting plasma glucose test is more sensitive than HbA1C, which is also known as glycated hemoglobin test for detecting blood sugar levels. One should always do the Fasting plasma glucose along with HbA1C to get a correct diagnosis. (Dr. Ashish Bajaj, M.B.B.S., M.D. in Clinical Pharmacology and Toxicology)
HOMA-IR Scale
Your results from the HOMA-IR test are displayed against a scale or range that determines the level of your insulin resistance. Low HOMA-IR implies you are sensitive to insulin and higher levels indicate insulin resistance and higher chances of you developing diabetes mellitus.
Initial diagnosis of diabetes should always be made by fasting blood sugar and post prandial blood sugar. For monitoring you can use HbA1c. Dr. M.G. Kartheeka, MBBS, MD(Pediatrics)
Ways to decrease your HOMA-IR scale
To properly be able to tackle decreasing insulin resistance, it is necessary to bring about changes in lifestyle and habits. There are two ways in which this could be achieved:
- Dietary changes- Reducing calorie and processed carbohydrates and increasing fibre intake.
- Lifestyle changes- Plenty of exercise and activity while avoiding prolonged periods of inactivity.
References:
- Gutch M, Kumar S, Razi SM, Gupta KK, Gupta A. Assessment of insulin sensitivity/resistance. Indian J Endocrinol Metab. 2015 Jan-Feb;19(1):160-4. doi: 10.4103/2230-8210.146874. PMID: 25593845; PMCID: PMC4287763.
- Ghazanfari Z, Haghdoost AA, Alizadeh SM, Atapour J, Zolala F. A Comparison of HbA1c and Fasting Blood Sugar Tests in General Population. Int J Prev Med. 2010 Summer;1(3):187-94. PMID: 21566790; PMCID: PMC3075530.
- Rao G. Insulin resistance syndrome. Am Fam Physician. 2001 Mar 15;63(6):1159-63, 1165-6. PMID: 11277552. https://www.aafp.org/pubs/afp/issues/2001/0315/p1159.html